Organization
PETER GRANT, MD, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER JAMES GRANT MD (PHYSICIAN)
(708) 524-1747
Entity
Organization
Contact information
Practice address
1011 LAKE ST, SUITE 300, OAK PARK, IL 60301-1148
(708) 524-1747
Mailing address
1131 LAKE ST, #214, OAK PARK, IL 60301-1001
(708) 524-1747
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
036108911
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03610891106
—
IL
Enumeration date
09/24/2007
Last updated
09/24/2007
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